I-CAN: Classification of Disability Support NeedsARC Linkage project partners:University of SydneyRoyal Rehabilitation Centre &Centre Developmental Disability Studies

Problems with past assessment Eligibility for service provision determined by disability definitions & classifications

Focus on strengths and weaknesses - deficit model

People with disabilities feel they are made to fit available programs

Significant gaps and overlaps in service provision occur

Fragmentation with different disciplines and different agencies working more or less in parallel

Requirements A rigorous and robust system to

accurately determine the type and intensity of support needed

Using a team approach Permit people with disabilities to

pursue their personal goals and chosen life activities

Ensure an equitable resource allocation

CONCEPTUAL FRAMEWORKS AAMR (1992, 2002) conceptualization of

supports.

WHO International Classification of Functioning, Disability and Health (ICF) (2001)

Health & Well Being

Activities & Participation

Environment & personal factors

SUPPORTS

“Supports are the resources and strategies that

aim to promote the development, education,

interests, and personal well-being of a person

and that enhance individual functioning.”

(AAMR, 2002, p. 151)

Supports enable individuals to live meaningful

and productive lives that they choose.

Figure 1: Supports model (Luckasson, et al., 2002).

Person’s Capabilities &Adaptive Skills

Risk/ ProtectiveFactors

Participation in Life Environments(Requirements & Demands)

Support Areas Human Development Employment Teaching & Education Health & Safety Home Living Behavioural Community Living Social Protection & Advocacy

Intensity ofSupport Need

Source of Support

Intensity ofSupport Need

Evaluation ofSupports

Support Functions Teaching In Home Living Assistance Befriending Community Access & Use Financial Planning Employee Assistance Health Assistance

Personal Outcomes Independence Relationships Contributions School & Community Participation Personal Well-being

Bio-psycho-social approach

The medical model views disability as a problem of the person, directly caused by disease, trauma or other health related conditions, & requiring medical care through individual treatment by professionals

The social model sees disability as a complex collection of conditions, many created by the social environment, & requiring social action & environmental modifications for full participation of people with disabilities in all areas of social life

ICF seeks a synthesis of these 2 opposing models

Functioning, Disability & Health Functioning encompasses all human

functions; at the level of the body, the individual and society

Disability is perceived as a multi-dimensional phenomenon resulting from the interaction between people and their physical and social environment

Health is defined as ‘a state of complete physical, mental and social well-being and not merely the absence of disease’.

(ICF, WHO, 2001)

Interaction of ConceptsInteraction of Concepts

Health Condition Health Condition (disorder/disease)(disorder/disease)

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body function & Body function & structurestructure (Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

ARC RESEARCH PROJECT

Development & trial of instrument & process

NSW, ACT, Vic & Qld

In residential & some day program settings

Process engaging 5071 participants

Trained facilitators

1012 complete data sets

People with disability

N=1012

Aged 17 - 77 years

Average age 41 years

Male 58% female 42%

Disability Groupings

Multiple disabilities N=290 28.7%

Intellectual only (ID) N=232 22.9%

ID & neurological N=156 15.4%

ID & mental illness N= 78 7.7%

ID & sensory disabilities N= 73 7.2%

ID & physical disability N= 56 5.5%

Other e.g. physical, ABI N=127 12.5%

Health and Well Being Scales

Physical health

Mental emotional health

Behaviour

Health Services

Health and Well being Total

Activity & Participation

Activity is the execution of a task or action by

an individual.

Participation is involvement in a life situation.

Activity limitations are difficulties an individual

may have in executing activities.

Participation restrictions are problems an

individual may experience in involvement in life

situations.

Activities & Participation Scales Knowledge and Tasks (KAT)

Mobility (Mob)

Communication (Com)

Self care & Domestic Life (SCDL)

Interpersonal Interaction & Relationships

(IIR)

Community, social & civic life (CSCL)

AP Total

Reliability Studies

Internal consistency alpha =.70 to .98

Inter-rater reliability = .99

Test-retest reliability = .21 to .94

Test -Retest Reliability

Overall reliability .21 to .94

Retest 6-12 months

r = .21 Physical Health Scale

r = .93 Mobility Scale

Retest at 2 years

r =-.22 Mental Emotional Health

r = .94 Mobility Scale

Validity Studies Moderate and significant correlations

between I-CAN domain scores and ICAP Service

Level Score co-efficients -.39 to -.62

Low to moderate correlations I-CAN Total & QOL-Q (Schalock & Keith, 1993)

Significant correlation between I-CAN Mental Emotional Health, Communication and IIR Scales and QOL-Q Community Integration/Social Belonging.

Participant evaluations

Positive feedback from:

People with disabilities

Trained facilitators

Family members and advocates

Support hoursMultiple regression analyses against

– Day time support hours– Night support hours– 24 hour support clock

Allocation of support hours includes up to 40% factors relating to the individual but the remainder appear to relate to organisational factors such as policies, staffing, resources

References for ICF

World Health Organization (2001). International Classification of Functioning, Disability and Health. Geneva: Author.

AIHW (2003) ICF Australian User Guide Version 1.0

http://www.aihw.gov.au/disability/icf ug/index.html